Presentation on theme: "Park Place Seniors Living"— Presentation transcript:
1Park Place Seniors Living Ethicsin aClient Centered ModelA Successful JourneyLouise Johnson RN., B.H.Admin
2Defining EthicsEven among the experts, there is no universally accepted definition of “ethics” or ethical behaviour. This is because ethics are culture and situation-specific: what is seen as ethical in one situation or culture may not be ethical in another.For example, limiting the freedom of another human being would beconsidered unethical in most situations. But if the person is a young child;or a senior with Alzheimer’s, it would be unethical to not limit that person’smovements, given the risk an unsecured environment poses to his or hersafety.“We are discussing no small matter but how we ought to live.”- Socrates, from Plato's Republic, Book 1:352d
3Ethics are in the eye of the Beholder What is defined as ethical choices may be influenced by:Acceptance of what is “good” and what is “right” within the broader culture;Conventions within a particular professional discipline;Personal belief systems;The desired outcome of any action/decision; andThe situation to which those conventions and belief systemsare to be applied.Asking individuals or an organizations to make choices based on ethicsis much more complex and requires a higher level of thought thansimply providing checklists, rules, or guidelines. This presentation outlineshow Park Place Seniors Living instituted client-centred ethical decisionmaking throughout the company’s 11 complex care homes.
4Flexible Decision Making Integrating an ethical choice process into decision making gives care givers the flexibility to respond better to individual situations and needs.Ethics-based decision making can beattuned to achieving desired end goals,instead of just following pre-determinedrules. It provides solutions in situations forwhich there may be no established rules.At Park Place, the following shared valueswere identified as the end goals of ourinteractions with residents, families andeach other. In all our interactions, wewant to maintain:Dignity, Respect, Trust and EmpathyMaintaining dignity, respect, trustand empathy across the generations.Establishing shared goals is a precursorfor ethical decision-making.noun (plural)/ˈeTHiks/ethics, plural1. Moral principles that govern a person's or group's behaviour (i.e. Judeo-Christian ethics)2. The moral correctness of specified conduct (i.e. the ethics of euthanasia)3. The branch of knowledge that deals with moral principles- Dictionary.com
5Steps towards Ethical Decision Making Creating an Ethical EnvironmentEstablishing a value-driven cultureClearly defining desired valuesEthical decision-making frameworkTeaching the decision-making processDeveloping new resourcesIntegrating into day-to-day operationEthical decision-making in actionMeasuring SuccessLessons LearnedFuture DirectionAbout Park Place Seniors Living
6Step 1: Creating an Ethical Environment Ethical choice is dependent on the culture and environment in which the choiceis made. Therefore, the first requirement for success in making Ethical Choices isto develop the appropriate Ethical Environment.Park Place has created the appropriate Ethical Environment by implementing:A values based organization with a true commitment to enriching quality of life forresidents and quality of work life for staff.Clearly defined and cohesive Mission, Vision and Values statements whichsupport ethical behaviours and goals.Integration of the company’s Mission, Vision and Values in the development ofcompany policies and operational choices.Educational and informational initiatives which repeatedly reiterate the corevalues of the company.Park Place has established a values-driven culture of care.
7Park Place Mission Step 1: Creating an Ethical Environment THE MISSION All photos are Park Place Seniors Living residents or staff – used with permission.Park Place MissionPARK PLACE SENIORS LIVING EXISTS TO PROVIDE ENRICHEDLIFE EXPERIENCES TO SENIORS BY PURSUING STRATEGIES FORINNOVATION, CREATIVITY AND LONG-TERM GROWTH IN AMANNER THAT IS SUSTAINABLE AND SECURES FAIR RETURNS FOR INVESTORS.The Park Place mission statement underlies the choices made by the company and balances the responsibility of providing exemplary care with the responsibility to be financially prudent. Financial stability allows the company to hire and retain the best people, maintain buildings, and offer enhanced programs.
8VISION: Guiding Principles Step 1: Creating an Ethical EnvironmentVISION & VALUESVISION: Guiding PrinciplesTreat others with dignity,respect, trust and empathyInvolve stakeholdersProvide appropriate servicesDeliver services thatmeet/exceed standardsBuild capacity withsupportive frameworksHonour commitments,agreements and wordsProvide high qualityand exceptional valueInvest in growthand sustainabilityMinimize financial riskVALUESStrive to serve our clients with excellence and build strong &mutually beneficial partnershipsAttract, hire, retain, develop and deserve the best peopleat all levelsDevelop facilities and services that have high qualityand exceptional valueBe good stewards of the company’s physical, financialand human resourcesTreat all people with respect, in a manner we wouldlike to be treatedDemand the best of ourselves and from othersTell the truth and be trustworthyBe the difference we wish to see in the industryMake sound financial decisions that support our mission; andHonour our words, agreements and promises.The above are Park Place’s Vision and Values and are providedonly as examples. Use your organization’s accepted values asthe basis of an ethical decision-making process.
9Step 1: Creating an Ethical Environment BRINGING IT HOMEAt the individual site level, the staff at each home work together to establish site goalswhich are consistent with the company Mission, Vision, Values and Strategic Directions.These Strategic Directions include:Enriching Lives of Seniors resident in the home and beyond;Embracing a Culture of Learning;Maintaining a Culture of Safety;Engaging in Ethical Decision Making;Establishing an Effective Communication Framework;Ensuring Human Resources Allocations supportWork-Life balance; andAdhering to the sound financial processes whichsupport the financial viability of the care homeand the company.Enriching the lives of seniors,as shown by this resident’s smile.Park Place clearly defines desired values as a first stepin making ethical decisions.
10Step 2: Ethical decision-making framework ESTABLISHING GOALSThe key measure of Ethical decision making is not whether a rule is upheld butwhether a goal – such as enriching a resident’s life – is achieved. At Park Place, thegoals are always clearly articulated, visible and front-of-mind for all staff.The Park Place Resident Bill of Rights is clearly posted in all care homes.The Bill-of-Rights gives staff an ever-present reminder of resident rights,which must be respected and honoured.Park Place core values include treating others with:Dignity;Respect;Trust; andEmpathyThese values are stressed throughout the company.Education on upholding these values is providedto staff, service providers, clients and families.Dignity must be maintainedso all residents can continue to enjoy their lives and relationships.Goals in care are front-and-centre every day in every care home.
11Step 2: Ethical decision-making framework THE CARE MODELThroughout the company, ethicaldecisions are made withinthe context of the Park PlaceResidential Care Model.Illustrated at right in a visual,poster format, the care modelestablishes the following five corecommitments to:An Enriching Culture (for seniors & staff)Follow Standards(Maintain) Holistic FocusMeasure Performance; andContinuous ImprovementThe Care Model establishes the operationalframework under which the Mission, Visionand Values are transformed into action.
12Step 2: Defining Ethical decision-making These commitments are honouredwhen developing the standardsand policies which govern thefollowing seven operational areas:PhilosophyStaffingEnvironmentPolicies & StandardsProgramsEducationQuality ImprovementBy developing this values-basedoperational framework, Park PlaceSeniors Living created a work andmanagement environment conduciveto ethical decision making.VALUE-BASED OPERATIONSA contented resident atHilton Villa in Surrey, B.C.
13Park Place Seniors Living Step 2: Ethical decision-making frameworkA VOICE AND A CHOICEAdditional core documents which establish aframework for ethical decision-making are known as “Resident’s Day.”Each resident of a Park Place Seniors Living home has a Resident’s Day document. These Resident Day documents are based on interviews with incoming residents – and/or family & friends – to determine how the resident wishes to live in the home.The resulting Resident Day document ensures each resident will be cared for as an individual with a right to a voice and a choice in his or her care. A sample is shown on the following page.Residential Care ModelResidents have a voice and a choicein their daily care.Resident’s Day was identified as a leading practiceby Accreditation Canada in the 2011 Park Place Seniors’ Living review.
14Park Place Seniors Living RESIDENT’S DAY: A VOICE AND A CHOICEIf an ethicaldecision affectsone resident, thedecision mademust fall withinthe provisions ofThat individual’sResident Daydocument.If an ethicaldecision affectsmore than oneresident – or theoperation of theentire care home –then the combinedResident’s Daydocuments of allaffected residentsmust be considered.Resident’s Daydocuments areamended asrequired toaddress resident’schanging needs.Resident’s Day – Gold Standard
15Step 3: Teaching the decision-making process DEVELOPING NEW RESOURCESIntegration of Ethics and Ethical Decision Making across all ParkPlace operations began in The new initiative includeddevelopment of materials, policies, procedures and training to turnethics into day-to-day reality for everyone.By 2007, the company had a completed Ethics Resource Manualwhich included:Code of EthicsTerms of ReferenceConsent Policy and ProcedureEthical DilemmasEthics FrameworkEducation and Research FunctionDisclosureCase StudiesArticles relating to Ethics issues
16Step 3: Teaching the decision-making process DEVELOPING NEW RESOURCESThe 2007 Ethics Resource Manual is available in each neighbourhood withinevery Park Place care home, so staff have an immediate reference should anethical issue arise.Park Place developed an easy-to-follow Ethical and Clinical Decision-MakingFramework Template, which is attached to the agenda of each Professional PracticeCouncil. This encourages immediate discussion and review of ethical issues as theyoccur.The formal ethics framework guides staff andmanagement through a step-by-step ethicaldecision-making process. The framework alsoaddresses issues of consent, disclosure andresearch.Ethical frameworks protect frail elderly residents.
17Step 3: Teaching the decision-making process INTEGRATING INTO DAY-TO-DAY OPERATIONSThe following practices integrate ethical choice into day-to-day work.Ethics orientation and staff development sessions provide staff with theknowledge and skills required to guide discussions when making decisionson ethical issues;All interdisciplinary Care Conferences include a review of care from an ethicalperspective. All members of the care team meet on a regular basis to discuss thecare provided to each resident. Ethical choices made for an individual are measuredagainst that resident’s wishes, as identified in the Resident’s Day.Ethical issues are also discussed at Resident and Family Councils. Thesecouncils promote the collective interests of all residents and provide an avenue forconsultation regarding any changes to policies and procedures.
18Step 3: Teaching the decision-making process INTEGRATING INTO DAY-TO-DAY OPERATIONSA user friendly brochure about ethics and ethical decision-makingis widely available for use by staff, volunteers, residents and families.Copies of the brochure are free.A brochure is freely available to help residents and family understand ethical issues.The ethics committees uses case-based learning – with identifying details removedfrom examples - to transform ethical dilemmas encountered at Park Place intoinstructional materials.
19Step 4: Ethical Decision-Making in action Sample of thestep-by-stepEthical &ClinicalDecisionMakingFramework
20Step 4: Ethical Decision-Making in action SAMPLE DECISION – the issueResident has a diagnosis of Parkinson’s with Speech Language Therapistrepeated assessments, the latest stating “pureed to minced textures astolerated, thin fluids by straw (small sips). Sit fully upright. Whole meds, astolerated.”Resident wishes to eat totally minced or cut-up versus puree.Professional assessment states puree and minced as tolerated, therefore notagreeing with resident wishes of minced or cut-up only.The conflict is between two important values: safety vs. quality of life.Pureed is the safest option but the resident has expressed a clear desire forminced or cut-up food. The son has signed a release to allow a one week trialof minced, with staff monitoring.ISSUE: The resident wishes to eat only minced or cut-up food but the professionalassessment includes pureed food. Which takes precedence: the resident’s wishes or theprofessional health advice?
21Step 4: Ethical Decision-Making in action SAMPLE DECISION – the debateFor staff, the conflict is between an obligation to do what is safest versusincreasing the resident’s quality of life.Resident eats in room alone without supervision and refuses to come to diningroom, making monitoring more difficult. The resident also refuses to move to atable closer to Nurses to allow closer monitoring.The son wants the resident to have the quality-of-life choice to eat what shewants and has signed a Managed Risk Authorization for a one-week trial ofminced or cut-up food.Possible responses are:Do nothing?Change residents’ behaviour – but how?Consider a policy changeAgreement and understanding of risksINVOLVED: Those affected by this decision include the Resident, Son/Family,Dietician, Nurses, Care Aides, Care Coordinator, Physician, Speech/Pathology,Administrator, Dietary Supervisor
22Step 4: Ethical Decision-Making in action SAMPLE DECISION – optionsUnder Resident’s Day and the resident-centered care model,“doing nothing” is not a viable choice since it ignores theresident’s wishes.Give cut-up to minced for one week – this honours theresident’s wishes and permits a trial period to assess theoutcome.Check the legal authority of son to sign Managed RiskAgreement to ensure the care home is protected.Consider Companion Care Assists for mealsGOAL: Honour the wishes of the resident/son within medically safe parameters.Ensure staff are comfortable with the outcome and revised care plan.Ensure all stakeholders have an opportunity to discuss the plan.
23Step 4: Ethical Decision-Making in action SAMPLE DECISION – The OutcomeThe Resident is considered to be competent to make her own decisions so thegoal is to support Resident’s wishes and to achieve a balance of those wisheswith the professional recommendations.Staff will monitor at meals which must be in the dining room. The Resident hassome loss of freedom but staff are protected from having to closely monitor inResident’s room.Beverages may be offered in room with a straw i.e. milkshakes and smoothies.Behaviour Mapping to commence regarding Resident’s feelings of satisfactionand tolerance of the diet.The Resident’s swallowing abilities often fluctuate day to day which willnecessitate frequent revisiting of a diet that can be tolerated.The son will be contacted to review/modify the Managed Risk Agreement.DOCUMENT OUTCOME: To ensure consistent action, the revised plan will bedocumented in the Resident’s Day, Progress Notes, Care Plans, andManaged Risk Agreement.
24Step 5: Measuring Success EXTERNAL MEASURESPark Place measures both the company’s ability to create an ethical environmentand the individual ethical decisions made within that environment.To evaluate the company’s Ethical Environment, Park Place measures itself against Accreditation Canada standards. These established standards are used across Canada to measure ethics within the health care field.Internally, Park Place maintains an extensive program of Quality Improvement Measures, which evaluate the provision of care throughout the company against recognized standards of practice. Quarterly reporting helps the company flag and investigate any variances in care outcomes.
25Park Place Seniors Living Step 5: Measuring SuccessINTERNAL MEASURESEthical issuesare a standardagenda item forPark Placestaff meetings.This ensurestimely reviewand assessmentof any issueswhich occur.Continualon-sitemonitoring ofethical issuesand decisionsproves theprogram works.PC Agenda
26Step 5: Measuring Success ANNUAL REVIEWSAnnual Performance/Accomplishment Reviews include consideration ofethical issues. Included is discussion of ethical dilemmas the staff may havefaced and resolved during the previous year AND/OR discussion of ethicalissues which may arise. Questions asked include:Have you faced an ethical dilemmain the past year related to health care?If yes, please share highlights of thedilemma and how it was resolved.If no, state what could be an ethicaldilemma related to health care andyour role in resolving it.Better care is an outcome ofincluding ethics in annual reviews.
27Step 5: Measuring Success EXTERNAL PRAISEIn June 2011 Park Place Seniors Living completed a comprehensiveAccreditation Canada review at 10 care homes. The review included a close look bythe six surveyors at how successfully Park Place handled Ethics, which is a prioritypractice for Accreditation Canada.The Accreditation review assessed Park Place’s:EthicsEthics frameworkEthics educationEffectiveness in resolving ethical dilemmasIn its preliminary report, the survey teamnoted, “There is a very strong ethicsframework. Staff know what ethics issues are.”Accreditation Canada survey team with(far left) Park Place Owner and PresidentAl Jina and (far right) Accreditation CoordinatorLouise Johnson.
28Lessons LearnedIn order to champion ethics, Park Place educated itself by researching various ethics frameworks and developing an easy-to-read ethics manual for staff. Thismanual includes a decision-making framework and terms that “make sense” to frontline staff.This resource guide includes a seven step decision-making model with flowchart and related policies. It is a very practical guide for a long term care environment and is useful in helping staff understand the role that they play in making ethical decisions, whether on administrative or clinical issues.The framework and seven step decision-making process have been used effectively at all PPSL Homes.Park Place Seniors Living has also integrated ethical issues into operations by including Ethics as a standing agenda items on departmental and quality meetings held throughout the year.Attaching the ethics reporting template to each meeting agenda encourages staff toIdentify ethical issues and record decisions, experiences, and outcomes. This buildsa larger company-wide pool of experience in handling ethical issues.
29Lessons LearnedThe combination of print material, readily available manuals, and inclusion of Ethicsas a standard topic in staff meetings has resulted in clear communication to staff on how to approach ethical decisions.Management at each home have been able to use the tools to build capacity for ethical decision making in their specific home.By developing the ethics process within the framework of the company’s Resident’s Day and Care Model, the resulting decisions reflect Park Place’s core values and focus on resident-centered care.Residents and/or their family members, friends or advocates are involved whenever there is an ethical issue which affects that resident. Their input is invited.Throughout, Park Place Seniors Living strives to ensure that every resident’s wishes are honored.The best advocates when resolving ethical dilemmas are often the resident,or a friend or family member who speaks on behalf of the resident.
30Future Direction Continue to develop an inventory of case studies, administrative and clinical, as aresource for all Homes.Continue to review ethical issues monthlyat Practice Council Meetingsand Leader Meetings.Include Ethics as an agenda item atquarterly Home Quality Meetings ineach Park Place Care HomeInclude Ethics within the program for thetwice-yearly Leaders Forum held with allcare home leaders and executive staff.Moving forward with enthusiasm!
31About Park Place Seniors Living Park Place Seniors Living is family owned company, founded, owned and operated by Al & Jenny Jina. Al is a lawyer by profession and Jenny is a nurse who specializes in geriatrics and adult education.The company was founded in 1993 with onesmall, private Care Home in Nelson B.C. Sincethen the company has grown to include 15 sites,offering a continuum of care from independentliving to assisted living to complex, continuingand dementia care. All sites are owned andoperated by the company from a small headoffice in Vancouver, B.C.Owner Al Jina (left) with a Park Placeresident and her husband.Park Place Seniors Living works in partnership with six regional healthauthorities in Alberta and British Columbia.Enriching the Lives of Seniors
32We are discussing no small matter but how we ought to live. Thank You – Questions?We are discussing no small matter but how we ought to live.- Socrates